Memorial Sloan-Kettering Cancer Center
New York, NY
Correspondence to: Nicholas J. Vander Els, MD, FCCP, Memorial Sloan-Kettering Cancer Center, Room C-678, 1275 York Ave, New York, NY 10021
To the Editor:
I read with interest the report by Pietropaoli et al (August
1999)1of a woman who developed sarcoidosis during
treatment of chronic myelogenous leukemia with interferon (IFN)-α. I
recently treated a similar patient and found two others reported in the
My patient was a 39-year-old woman who was admitted to Memorial
Hospital in May 1999 for fever, polyarthralgias, and erythema nodosum.
Four weeks earlier she had completed a 1-year course of IFN-α (3
million units tiw), given with 6 months of ribavirin (1 g
qd) as treatment for hepatitis C. In the past she had a self-limited
thyroiditis. Her chest radiograph demonstrated new hilar adenopathy
without parenchymal disease. The results of a skin biopsy were
compatible with erythema nodosum. Her angiotensin-converting enzyme
(ACE) level was 155 U/L. The results of pulmonary function tests were
normal. A transbronchial needle aspiration of the right hilar lymph
node revealed granulomas, as did endobronchial and transbronchial
biopsies. She received prednisone, 40 mg daily, giving her rapid relief
from fever and joint pain. The dosage of prednisone has been tapered.
After 8 weeks, her ACE level was 46 U/L.
In the two additional cases in the literature, one patient had received
IFN-α for hepatitis C.2She had pulmonary and cardiac
involvement with the development of complete atrioventricular block.
The other patient had been treated with IFN-β for multiple
As noted by the authors, α- and β-interferon have not been
classified in the pathogenesis of sarcoidosis, but in vitro
they can activate alveolar macrophages in sarcoidosis
Our patients seem to have had an iatrogenic stimulation of the
immunologic pathway of sarcoidosis. Whether they have a genetic
disposition or have had an exposure to the presumed antigen is
speculative. It would be interesting to have them undergo Kveim
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